Musculoskeletal ultrasound features of gouty arthritis during different episodes

目的：研究并比较痛风患者急性发作期和既往受累关节的超声表现。方法共入组64例处于急性发作期的痛风患者，其中21例为首次发作。收集临床资料，对急性期受累的关节进行超声检查。30例患者检查了既往受累关节，23例患者检查了临床从未受累关节。总结并比较了各组间超声下滑膜炎、双轨征、痛风石、骨侵蚀等病变的发生率和差异，并分析了超声下病变及其与临床特征的关联。采用字2检验和Logistic二元回归进行统计学分析。结果急性期受累的关节中MTP1发生率最高（27例，42%），7例（9%）患者为多个部位同时受累。急性期受累关节的超声表现中，滑膜炎发生率最高（46例，74%），其次为双轨征（18例，28%）、骨侵蚀（12例，19%，1例为首次发作）、痛风石（10例，16%，均为非首次发作患者），23例患者36%的患者同时存在2种及以上的病变。30例患者检查了既往受累的关节，双轨征的发生率最高（10例，33%），其次为痛风石（18例，27%）、骨侵蚀（7例，23%）、滑膜炎（4例，13%）。23例患者检查了临床从未受累的关节，未发现上述病变。急性发作期受累关节部位滑膜炎症的发生率远远高于既往受累关节（分别为80%和13%，χ2=20.475，P<0.01），而双轨征、痛风石更多见于既往受累的关节中（分别为10%和33%以及0和27%，χ2=3.892，6.642，P均<0.05）。双轨征和痛风石均与病程呈正相关。结论痛风患者急性期受累关节以滑膜炎症表现最显著，某些患者首次发作时即存在骨侵蚀。双轨征和痛风石的发生率随病程升高。未处在急性发作期的关节仍然存在亚临床的滑膜炎症。Objective To investigate the ultrasound features of gouty joints during acute and past attacks. Methods Clinical data and ultrasound features of joints during the acute and past attacks of gouty patients who were experiencing an acute attack were collected. The differences of ultrasound features between two episodes, as well as the relationship with clinical characteristics were analyzed. Results Sixty-four patients were enrolled with 21 (33%) patients at their first attack. The first metatarsophalangeal (MTP1) joints were most frequently involved, meanwhile, 9.4% patients had two or more joints attacked during one episode. The most prevalent feature was synovitis at the acute phase, followed by double contour (DC) sign (18 cases, 28%), bone erosion (12 cases, 19%) and tophi (10 cases, 16%), while 23 patients had two or more pathological changes. Whereas, the DC sign was found most in previously attacked joints (10 cases, 33%), followed by tophi (8 cases, 27%), bone erosion (7 cases, 23%) and synovitis (4 cases, 13.3%). No positive pathological changes were found in asymptomatic joints. Synovitis was more common in joints during their acute attacks (80% vs 13%, χ2=20.475, P<0.01), however, DC sign and tophi were more common in previous attacked joints (10% vs 33% and 0 vs 27%, χ2=3.892, 6.642, P<0.05, respectively). Both the DC sign and tophi were positively correlated with the disease duration. Conclusion Synovitis is the most prevalent feature in gouty joints during acute episodes; even bone erosion can be found at the first attack. The DC sign, tophi and bone erosion are common in past attacked joints. The prevalence of both DC sign and tophi are increased along with disease durations. Subclinical synovitis can be detected in a small past of joints which are not at acute attack.首都卫生发展科研专项(2011-4021-03)；北京大学第一医院科研基金Fund program:The Capital Health Research and Development of Special; Research Foundation of Peking University First Hospital中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)123-272